My thoughts:
I'm just really waiting for FMT pills to be used in IBD, but this study helps give the idea of FMT more merit because it was a placebo controlled study and demonstrated much greater efficacy compared to placebo. Supposedly these are some of the best ways to demonstrate the effectiveness of any therapy, but even in some single case studies FMT has shown such a dramatic effect, it's hard to ignore, but this study will always help further the cause.

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This is the first trial that I've seen that "does it right", with respect to number of infusions.

Forty-one adults were treated with an initial fecal microbiota transplantation, delivered by colonoscopy, followed by five active enemas per week for 8 weeks.

They all started out with an empty colon and they did plenty of infusions using multiple donors. It was an "open label" study, though. It doesn't say what the placebo group did...maybe they gave them sterilized (killed) FMTs? I can't imagine why someone would knowingly go through 40 worthless enemas. It does say that 37 (of the 40) in the placebo group switched to live FMTs after 8 weeks. Maybe the option to switch is why they did 40 worthless ones.

The study says that 37% got a response and 17% got remission of their UC. Of those that switched at week 8, 27% got a response (compared to the 37%).

To me, this is essential information if someone with UC is considering the FMT route since it gives them an idea of how likely it is that they will get benefit (in the 30% range). It's still a roll of the dice, but it's better than the sketchy information I had a few years ago.

Improvements for the next study might include being double blind, large, and possibly using Borody's antibiotic cocktail the week before.

This is the first trial that I've seen that "does it right", with respect to number of infusions. They all started out with an empty colon and they did plenty of infusions using multiple donors. It was an "open label" study, though. It doesn't say what the placebo group did...maybe they gave them sterilized (killed) FMTs? I can't imagine why someone would knowingly go through 40 worthless enemas. It does say that 37 (of the 40) in the placebo group switched to live FMTs after 8 weeks. Maybe the option to switch is why they did 40 worthless ones.

The study says that 37% got a response and 17% got remission of their UC. Of those that switched at week 8, 27% got a response (compared to the 37%).

To me, this is essential information if someone with UC is considering the FMT route since it gives them an idea of how likely it is that they will get benefit (in the 30% range). It's still a roll of the dice, but it's better than the sketchy information I had a few years ago.

Improvements for the next study might include being double blind, large, and possibly using Borody's antibiotic cocktail the week before.

I agree, maybe they were glad to have the opportunity to get the real treatment after the placebo enemas, the fact that they began to respond to real stool helped emphasize the effect of FMT. For the record, right now FMT is still an experimental treatment option for IBD that's being explored and not ready for everyone to do, except for some well informed adventurous folks like myself.

wow I missed this study from 2014, it further makes connections between the gut bacteria and the regulation of the immune system specifically in IBD patients. More evidence to encourage the restoration of the microbiome through Fecal transplants.

A new story of a guy who did a DIY fecal transplant. not just any guy though he is also scientist.

That’s not to say Zayner is dubious of science — in fact, he’s a scientist himself. In 2013, he earned a PhD in Biophysics from the University of Chicago and subsequently served as a postdoc researcher at NASA’s Ames Research Center for two years.

My thoughts:
I'm just really waiting for FMT pills to be used in IBD, but this study helps give the idea of FMT more merit because it was a placebo controlled study and demonstrated much greater efficacy compared to placebo. Supposedly these are some of the best ways to demonstrate the effectiveness of any therapy, but even in some single case studies FMT has shown such a dramatic effect, it's hard to ignore, but this study will always help further the cause.

Hi, this is great. If crohn's was just an autoimmune disease - I dont think fmt would work because your not altering the immune system - so there must be more to it

Here is link to a recent study covering the dizzying complexity of trying to answer the question of whether microbiome alterations/disruptions are the cause or the result of IBD. It is now clear that there are major alterations in the microbiome, we just don't fully understand the implications and meaning of this data. It seems it is still possible the microbiome could be the sole cause if IBD as opposed to genetic mutations/heredity. Attempting to normalize the altered microbiome in IBD patients to appear more normal/healthy to improve or cure the disease is what Fecal Microbiota Transplants are all about.

Here is link to a recent study covering the dizzying complexity of trying to answer the question of whether microbiome alterations/disruptions are the cause or the result of IBD. It is now clear that there are major alterations in the microbiome, we just don't fully understand the implications and meaning of this data. It seems it is still possible the microbiome could be the sole cause if IBD as opposed to genetic mutations/heredity. Attempting to normalize the altered microbiome in IBD patients to appear more normal/healthy to improve or cure the disease is what Fecal Microbiota Transplants are all about.

This is very interesting, thank you! I do think fecal transplants are a big piece of the puzzle as will other methods to help clear out any existing pathogens in the system. It is nice that people are researching the CAUSE of the disease now as a trend, rather than the symptoms.

Scared1, you may be interested in the site thepowerofpoop.com whose original curator was somewhat of a pioneer in bringing together a lot of information regarding FMT to the web. And in particular, given the sort of companies you're linking, you might be interested in the listings on this page, where a lot of the companies that were/are doing next-generation FMT research (e.g. poop in a pill) are listed. You'll see Seres, Enterome, Second Genome, Vedanta and some other less known names. And many of these companies are now backed by the giants of the Pharma industry. True, it's an exciting field, but so far, definitely promising research in recurrent CDI, and to some extent UC, but I haven't seen anything too exciting yet for CD. I'm keeping my fingers crossed though.

I'm pretty sure this is in this thread somewhere, but it doesnt hurt to bring it up again because it is awesome. There is also a synthetic FMT pill being studied right now for crohn's. The pills are usually a selected mixture of different types of good bacteria.

I'm pretty sure this is in this thread somewhere, but it doesnt hurt to bring it up again because it is awesome. There is also a synthetic FMT pill being studied right now for crohn's. The pills are usually a selected mixture of different types of good bacteria.

Yeah, I didn't see it anywhere. I find this very interesting and I hope it leads to something in the next few years. I know there is a version for the pill - except the website just talks about the UC one but they are doing the same thing.

I really think the whole dysbiosis is a piece of it - not the whole piece to the puzzle. But, with that said, its a BIG piece of it and I am following so many trials and news on a daily basis (weird, it has become part of my morning coffee routine - sit and literally look at any postings/news/etc from the prior 24 hours), and it helps seeing that there are some interesting things in the pipeline:-)

Yeah, I didn't see it anywhere. I find this very interesting and I hope it leads to something in the next few years. I know there is a version for the pill - except the website just talks about the UC one but they are doing the same thing.

I really think the whole dysbiosis is a piece of it - not the whole piece to the puzzle. But, with that said, its a BIG piece of it and I am following so many trials and news on a daily basis (weird, it has become part of my morning coffee routine - sit and literally look at any postings/news/etc from the prior 24 hours), and it helps seeing that there are some interesting things in the pipeline:-)

Wow, that's even more antibiotics than AMAT! Shorter duration though. Not thrilled about the PEG.

I know! All antibiotics - here is a "layman version" per the website abstract:

The available evidence suggests that it is the commensal gut microbiota responsible for the stimulation of the intestinal immune system in the inflammatory bowel diseases (IBD). Thus, many IBD researchers and providers have questioned the current therapeutic approach. For instance, if the gut flora plays a role in the development of IBD, then perhaps targeting the microbes rather than the immune system, or an approach which targets a combination of the two, would be more efficacious.

We hypothesize that immune suppressive medications lead to persistent colonization with potentially pathogenic microbes that perpetuate disease chronicity in IBD patients. Additionally, we hypothesize that host immunosuppression could allow indolent colonizers of the colonic mucosa (symbionts) to behave as pathobionts, thereby causing progressive loss of response (LOR) to immune suppression. About 50% of patients with IBD lose response to conventional, immune suppressive medications for reasons that cannot be explained by the pharmacokinetics and pharmacodynamics of the drugs. This is a major challenge faced by providers who care for patients with IBD.

This study would evaluate for microbes that become more abundant in the feces of patients with IBD who are treated with immune suppression. This alone would represent a significant advance in the field. As proof of concept, we will then attempt to fundamentally change the intestinal environment. We will change the gut microbiota with a colonoscopy preparation, antibiotics, and an anti-fungal medication. We will allow the inflamed gastrointestinal tract a “Holiday” from gut microbes that may be perpetuating the inflammatory response. We will be studying this intervention in the sickest of IBD patients, ages 3-70, who are refractory to conventional therapies, in an attempt to “reset” the luminal environment and either treat the disease itself, or rescue response to therapy. This study could lead to new therapies for IBD and it will also advance our understanding of the gut flora in this vulnerable population.

I couldn't find anything (yet) if this short term antibiotic (very aggressive) regime is intended as a "Cure" meaning no maintenance after and why these were selected - I am hoping to find some info to see. I mean why this pattern of administering these antiobiotics in a successive way and what science was behind it, curious to see if it is similar to the whole pathogen concept like SSI and MAP. At least it is encouraging to see SOME shift -I will post whatever info I find:-)

I think this is a horrible idea to give someone all these antibiotics when we already suspect the destruction of the natural microbiota to be the cause of many diseases. If anything, they should try to select antibiotics specific to a certain group of pathogens and also try to verify the good bacteria will not be affected by the antibiotics.

If I were to approve such a study those would be the only criteria under which something like this would be tried. Also start in mice and rats first as usual for any groups of chemicals, and only after that perhaps on only a few patients because who knows what could happen.

I think this is a horrible idea to give someone all these antibiotics when we already suspect the destruction of the natural microbiota to be the cause of many diseases. If anything, they should try to select antibiotics specific to a certain group of pathogens and also try to verify the good bacteria will not be affected by the antibiotics.

If I were to approve such a study those would be the only criteria under which something like this would be tried. Also start in mice and rats first as usual for any groups of chemicals, and only after that perhaps on only a few patients because who knows what could happen.

I wouldn't rule it out - I mean, I am just curious to see what the reasoning is - perhaps they are trying to aggressively kill of the bad bacteria and these antibiotics were selected for a reason - too soon to tell. At least they are trying to look at the CAUSE as opposed to another symptom focused treatment. I do think that this is a step in the right direction from that regards, whether or not the reasoning is as sound right now - I can't tell, too premature without further data. I always check those clinical trials - I like to see what the status is and it gives you a nice overview. Interesting, I was looking at historical archives of PUD (Peptic Ulcer Disease) and here is some clips I found in scientific articles at the time (this is an article from 1985):

"Genetic factors appear to play a role and a polygenic mode of inheritance has been proposed. Emotional factors also seem to be important. Children with peptic ulcer disease tend to be of above-average intelligence, are often overachievers who have trouble dealing with frustation, and tend to internalize their feelings. Hydrochloric acid has traditionally been implicated in the pathogenesis of peptic ulcer and most therapies are directed at either "neutralizing" acid or blocking its secretion. Recently, local factors such as gastric mucus, alkaline secretion by the gastric mucosal cells, gastric blood flow, and prostaglandins have been shown to be important in local tissue resistance to acid and to digestive enzymes. The diagnosis of peptic ulcer disease depends on a high index of suspicion. Although pain is the most common symptom, there is no typical or characteristic pattern. Nausea and vomiting may also occur in conjunction with the pain."

I can't help but notice the similarities with that and how Crohn's is being looked at - i.e. genetic implications, treating the symptoms, etc...Just thought it was interesting because it seems to be history may be repeating itself. I am just glad I am seeing more and more related to treatment of actual disease rather than the manifestations of the disease - if the MAP vaccine works and SSI works - then I would push for my husband to do both treatments, honestly, because I am sure there may be more than one pathogen or maybe just one (either way), going that route makes a world of a different then living on what medication can I use next as I get worse and worse....and after reading everyone's stories on these forums, it breaks my heart all the time and hope it doesn't always have to be this way....

I at least like that they are moving away from immunosuppresives! I kind of agree partly with Wildbill, in that I'd be curious to see which microbes they're targeting and with what meds. I worry about damaging things with AMAT, but at least I know I am specifically targeting something that I have tested culture positive for. It's likely killing more, and I may be on to fecal transplants after AMAT, but since I feel so well and that has corresponded with a large drop in my mycobacteria culture load, I deal. I still think some of this microbiota research, while super interesting, is destracting to the debate of MAP. Wish they'd just fund the full MAP research and give us proof once and for all! Then we can move on to looking for other harmful pathogens.